Healthcare Provider Details

I. General information

NPI: 1174594071
Provider Name (Legal Business Name): DAVID ARDEN HULL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC EVANS ARMY COMMUNITY HOSPITOL ROBINSON CLINIC
FT. CARSON CO
80913-4604
US

IV. Provider business mailing address

USA MEDDAC EVENS ARMY COMMUNITY HOSPITOL 1650 COCHRANE CIRCLE ATTN: CREDENTIALS OFFICE
FT. CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7764
  • Fax: 719-524-2258
Mailing address:
  • Phone: 719-526-7844
  • Fax: 719-526-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35407
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01566
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0046223
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: